Healthcare Provider Details

I. General information

NPI: 1588621304
Provider Name (Legal Business Name): SHEA M HERMES NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 STEWART AVE
SAINT PAUL MN
55102-4119
US

IV. Provider business mailing address

720 STEWART AVE
SAINT PAUL MN
55102-4119
US

V. Phone/Fax

Practice location:
  • Phone: 651-225-8350
  • Fax:
Mailing address:
  • Phone: 651-225-8350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1183311
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN 079301
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: